Outline

Objective

To investigate the efficacy and to document the functional outcome of photodynamic therapy (PDT) with Verteporfin in patients with choroidal neovascularization (CNV) associated with angioid streaks.

Methods

12 patients with CNV due to angioid streaks were included in this non-randomised clinical investigation. They underwent visual acuity testing, ophthalmic examination, color fundus photography and fluorescein angiography. Retreatment was based on criteria from the treatment of age-related macular degeneration with photodynamic therapy investigation (TAP study). To be included the following criteria had to be present: a decrease in visual function (visual acuity), visual symptoms (e.g. metamorphopsia) and a CNV located sub-, juxta- or extrafoveally. PDT was performed with Verteporfin at a concentration of 6 mg/qm body surface area and a light dose of 50 J/qcm at 692 nm.

Results

The mean follow-up time was 21 months (9-38 months). The mean number of treatment sessions was 3,4 (range 2-5). Visual acuity improved by at least one line in 26%, was stable in 34% and decreased by at least one line in 40 % of the patients. 2 patients had a decline in visual acuity by more than 5 lines. Mean visual acuity was 0,34 (range 0,1-0,5) and 0,28 (range 0.04-0.6) prior and after final PDT, respectively. Enlargement of CNV was noted in all cases at the final follow-up (mean 4140 micrometer) compared to the lesion size prior PDT (2340 micrometer). There was an association between the number of treatments and the final visual acuity.

Conclusions

PDT for CNV associated with angioid streaks does not appear to limit the growth and size of CNV. However, while up to 50% become legally blind by age of 50 without treatment, PDT offered an opportunity to stabilize macular function and visual acuity in up to 60% of patients enrolled in our study. However, treatment modalities for CNV associated with angioid streaks have to be optimized to improve the final visual outcome of these patients.